Why is Bruce Springsteen’s stomach ulcer taking so long to heal?

Last month, rock and roll he-man Springsteen cancelled a US tour to deal with peptic ulcer disease.

A peptic ulcer is an open, inflamed sore or raw area in the lining of the stomach. It can also occur in the upper part of the small intestine: this is known as a duodenal ulcer. Sometimes an ulcer can develop in the lower esophagus.

A week ago, Springsteen hosted an episode of his radio show From My Home To Yours (the first in two years) to provide an update to fans.

Introducing himself as “your favourite rock star with a bitch of a bellyache”, he apologised for the show cancellations. And he thanked his fans for their understanding.

He said: “I am deeply sorry but this belly thing, despite my ability to laugh at it, has been a monster and is still unfortunately rocking my internal world.”

It wouldn’t be an unreasonable expectation that Springsteen might be on the mend.

This is because stomach ulcers often heal within four to eight weeks, when treated.

But they can take more than three months to resolve, depending on their size or cause or complications with the treatment.

So what is this monster?

Ordinarily, the lining of the stomach is protected from digestive acid and enzymes by a thick covering of mucus.

But sometimes, for different reasons, this lining breaks down.

A peptic ulcer is a sore on the lining of your stomach or small intestine. Image: Mayo Clinic

In its early stages, this breakdown will cause the tissue to become swollen and inflamed. This is known as gastritis. Mild cases of gastritis can generally be treated with over-the-counter drugs that protect the lining against stomach acid.

When this inflammation develops into an open and sometimes bleeding sore, you have an ulcer.

As it goes with any problem with the body, the sooner an ulcer is diagnosed and treated, the better.

When left untreated, and unprotected, an ulcer can, in effect, burn its way through the lining of the stomach. This creates a hole that lets food and digestive juices leak out of the digestive tract. This is called a perforation and is a medical emergency.

Perforated peptic ulcers have a mortality rate that approaches 30 per cent.

What causes an ulcer?

The most common cause of a peptic ulcer is an infection of the stomach by bacteria called Helicobacter pylori (H. pylori).

Most people with peptic ulcers have H. Pylori bacteria living in their digestive tract. However, many people (85-90 per cent) who have these bacteria do not develop ulcers.

The other major causes of peptic ulcers is the high use of non-steroidal anti-inflammatory drugs (NSAIDs).

These include aspirin and ibuprofen (such as Nurofen).

A combination of frequent NSAID use coupled with an H. pylori infection is more likely to damage the mucus layer, and that damage can be more severe.

Paracetamol reportedly doesn’t carry this complication.

NSAID use is more likely to cause a peptic ulcer if you’re aged 70 or older; are female; use corticosteroids at the same time as taking NSAIDs; use NSAIDS habitually for a long time; or have a history of ulcer disease.

Some risk factors

• Drinking too much alcohol.
• Smoking cigarettes or chewing tobacco.
• Being very ill, such as being on a ventilator.
• Liver, kidney or lung disease.
• Radiation treatment.
• Family history of ulcers.
• Stress.
• A rare condition, called Zollinger-Ellison syndrome, causes the stomach to produce too much acid, leading to ulcers.

Symptoms

In the early stages, or with a small ulcer, there may be no symptoms. Sometimes an ulcer will heal itself. But that’s not overly common.

Abdominal pain is the most common symptom of a peptic ulcer. The pain may be dull or burning and may come and go over time. This pain can be accompanied by bloating, belching and nausea.

You might mistake these symptoms as mere indigestion. If they persist, see your doctor.

In severe cases, symptoms can include:

• Dark or black tarry stool (due to bleeding).
• Vomiting red blood.
• Chest pain.
• Weight loss.
• Severe pain in your mid- to upper-abdomen.
•  Feeling dizzy, fainting or symptoms of shock.

These symptoms could indicate a complication with our ulcer. You should seek medical help immediately.

Diagnosis and treatment

Your doctor may refer you for an EGD or upper endoscopy.

This is a procedure that allows the doctor to examine the inside of the esophagus, stomach, and duodenum. You will be sedated during the procedure.

Your doctor will also refer you for a H pylori breath test to see if your stomach is infected with these bacteria. Otherwise, biopsy for evidence of H. pylori might be taken when you have the EDG.

Treatment is ordinarily simple: antibiotics to kill the H. pylori, and drugs to reduce acid levels in the stomach.

For more information about diagnosis and treatment, see here.